• Schistosoma infection
• appendicitis
• schistosomiasis

• Appendix
• Clinicopathological characteristics
• Colorectal cancer
• Schistosomal appendicitis
• Schistosomiasis

• Schistosoma ova
• Acute appendicitis
• Bilharziasis
• Schistosomal appendicitis

• Humans
• Appendicitis/parasitology
• Appendicitis/diagnosis
• Male
• Young Adult
• Praziquantel/therapeutic use
• Appendectomy
• Anthelmintics/therapeutic use
• Schistosomiasis/diagnosis
• Schistosomiasis/drug therapy
• Schistosomiasis/complications
• Diagnosis, Differential
• Abdominal Pain/etiology
• Abdominal Pain/parasitology
• Ultrasonography
• Animals
• Treatment Outcome
• Appendix/parasitology
• Appendix/pathology
• Appendix/diagnostic imaging

• Prevalence
• appendicitis
• histopathological methods
• parasitic infestation
• worldwide

• Animals
• Appendicitis/epidemiology
• Appendicitis/parasitology
• Appendicitis/surgery
• Ascaris lumbricoides
• Feces/parasitology
• Humans
• Intestinal Diseases, Parasitic/epidemiology
• Intestinal Diseases, Parasitic/parasitology
• Parasites
• Prevalence
• Public Health

Introduction

The appendix is considered an appendage of little value and is often treated disdainfully, be it as part of evolutionary process, on a grossing table, under a microscope or while archiving specimens and slides. It is only recently, with data indicating its importance in gut immunity and as the origin of pseudomyxoma, that its space in a human body appears vindicated.

Aim

Our aim was to screen the histopathologic spectrum of appendix lesions observed in our hospital for rare, incidental or clinico-radiologically uncertain lesions that would help emphasize a necessary seriousness in its sampling.

Method

All appendectomy specimens over ten years were screened for diagnosis other than acute/chronic/resolving appendicitis and pseudomyxoma peritonei. Among the recorded rare diagnoses, one representative case each, based on interesting history or pathology, was selected for discussion.

Observation

Forty-three lesions were found to meet inclusion criteria comprising 12 varied etiologies. Among these, 25 had a normal-appearing appendix and 27 were not suspected on radiology or on clinical/surgical assessment. Histopathology comprised, among others, neoplastic entities such as (Diffuse large B-cell) lymphoma, metastasis, carcinoid as well as interesting non-neoplastic diagnoses such as pinworm infestation (in the elderly) and (post-menopausal) endometriosis.

Conclusion

Sampling and histopathologic assessment of the appendix should be compulsory, careful and representative. Each specimen must be treated as harboring a potential pathology, until microscopically proven otherwise because missed “rare” diagnoses could delay therapy or alter key management decisions as cancer staging.

• appendicitis
• computed tomography
• histopathology
• schistosomiasis

• Intestinal Schistosomiasis
• Multislice computed tomography
• Peri appendiceal abscess
• Schistosoma japonicum
• curvilinear calcifications

• Adult
• Age Factors
• Aged
• Animals
• Appendectomy
• Appendicitis/diagnostic imaging
• Appendicitis/pathology
• Appendicitis/surgery
• Appendix/diagnostic imaging
• Appendix/pathology
• Appendix/surgery
• Diagnosis, Differential
• Female
• Humans
• Male
• Middle Aged
• Reproducibility of Results
• Retrospective Studies
• Schistosoma japonicum
• Schistosomiasis japonica/diagnostic imaging
• Schistosomiasis japonica/pathology
• Schistosomiasis japonica/surgery
• Sensitivity and Specificity
• Tomography, X-Ray Computed/methods

Schistosomiasis is prevalent in tropical and subtropical areas and rarely reported in developed countries. Schistosomiasis often occurs as a chronic illness, which can cause liver and intestinal damage. Appendicitis is an unusual complication of schistosomiasis. We herein present a case of acute appendicitis associated with the presence of schistosome eggs in a sailor from the Philippines.

A 34-year-old Filipino man who worked as a sailor presented to our hospital with a 2-day history of acute right lower quadrant abdominal pain and fever. A physical examination revealed right lower quadrant abdominal pain with signs of peritoneal irritation, including rebound tenderness. Computed tomography revealed thickening of the appendix associated with mural calcification and fluid collection around the cecum. Based on these findings, the preoperative diagnosis was acute appendicitis. Laparoscopic appendectomy was performed. Swelling of the appendix and contaminated ascites were observed intraoperatively, but there was no evidence of appendiceal perforation. A histopathological examination showed inflammation of the appendix wall and numerous ovoid bodies present within the submucosa, many of which were calcified. Severe infiltration of lymphocytes and fibrosis were recognized around the oval bodies. The numerous oval bodies were morphologically consistent with schistosomiasis. The final diagnosis was acute phlegmonous appendicitis associated with the presence of schistosome eggs. We examined the patient for signs of adult worm activity, but the results of stool ova and parasite examinations performed twice were negative. He was discharged and returned to his country on postoperative day 9.

The incidence of schistosomal appendicitis, which is seldom reported in developed countries, is expected to increase in Japan in the near future. Clinicians should suspect schistosome eggs as a cause of acute appendicitis in patients who have emigrated from or are traveling from endemic areas, and when mural calcification of the appendix is observed on imaging.

• Appendicitis
• Appendix
• Mural calcification
• Schistosomal appendicitis
• Schistosomiasis

• Appendicitis
• Schistosomiasis

•

Schistosomiasis as an unusual case of acute appendicitis, especially in non-endemic areas, where several cases of schistosomial appendicitis have been reported in our article due to globalization.

Appendicular schistosomiasis is an unusual etiology of acute appendicitis, which has been reported in countries endemic in schistosomiasis, such as sub-saharan Africa and South America. Nowadays, due to globalization, this disease has been diagnosed in non-endemic countries. Kuwait is a country possessing a larger percentage of foreigners than national citizens. Therefore, several cases of schistosomal appendicitis were found.

The clinicopathological records of all patients that underwent appendectomy during January 2007 and December 2011 were recorded from the archives of Al-Adan Hospital in Kuwait. All cases of schistosomal appendicitis were retrieved and the histopathologic slides reconfirmed by the histopathologist.

During the 5-year study period, 3012 appendectomies were performed and 8 schistosomal appendicitis were found. They were all Egyptian males that were admitted for a clinical suspicion of acute appendicitis. The age ranged between 24 and 42 years, with a mean age of 32.75 years. All cases showed histological features of acute or acute suppurative inflammation, with ova seen in the vasculature of all layers of appendicular wall.

Although schistosomiasis is a rare causative agent of acute appendicitis, this however can’t be confirmed until histological evaluation. Therefore, adequate follow up postoperatively is necessary to insure eradication of the disease and to prevent further serious consequences.

• Acute appendicitis
• Kuwait
• Schistosomal appendicitis
• Schistosomiasis
• Surgery

• appendix
• bilharzioma
• intestinal obstruction
• schistosomiasis

A 67-year-old man from Jingzhou was admitted to the First Hospital Affiliated to Yangtze University in July 2013 with sudden onset of abdominal pain with dizziness for 12 h. The patient had sign of peritoneal irritation. Ultrasonography of the abdomen and pelvis showed hepatic fibrosis due to schistosomiasis. Computed tomography showed free gas in the peritoneal cavity. Plain abdominal radiography showed bilateral subdiaphragmatic accumulation of gas, perforation of the viscus, and radio-opacity in the left renal area. The patient underwent emergency exploratory laparotomy. At laparotomy, a moderate amount of muddy yellow pus was found in the intra-abdominal cavity. At the junction of the jejunum and ileum, about 250 cm from Treitz’s ligament, there was an about 10-cm length of inflamed small bowel with perforation (3 mm in diameter) along the mesenteric border at the middle of the lesion. The patient underwent resection of the affected intestinal segment, along with end-to-end intestinal anastomosis. Histopathological examination revealed mucosal necrosis and hemorrhage with a large number of infiltrating eosinophils and neutrophils, and acute submucosal inflammation with a large number of infiltrating eosinophils and neutrophils associated with Schistosoma japonicum (S. japonicum) eggs. No intravascular adult parasite was found. Postoperatively, the patient was treated with praziquantel (30 mg/kg daily) for 4 d. The patient progressed well. To the best of our knowledge, this is the first case of small bowel perforation associated with eggs of S. japonicum.

• Schistosoma japonicum
• Intestinal perforation
• Small bowel

• Abdominal Pain/parasitology
• Aged
• Animals
• Biopsy
• Digestive System Surgical Procedures
• Humans
• Intestinal Diseases, Parasitic/diagnosis
• Intestinal Diseases, Parasitic/parasitology
• Intestinal Diseases, Parasitic/therapy
• Intestinal Perforation/diagnosis
• Intestinal Perforation/parasitology
• Intestinal Perforation/therapy
• Intestine, Small/parasitology
• Intestine, Small/surgery
• Peritonitis/diagnosis
• Peritonitis/parasitology
• Peritonitis/therapy
• Schistosoma japonicum/isolation & purification
• Schistosomiasis japonica/diagnosis
• Schistosomiasis japonica/parasitology
• Schistosomiasis japonica/therapy
• Schistosomicides/therapeutic use
• Treatment Outcome

Schistosomiasis is one of the neglected tropical diseases caused by a trematode, Schistosoma spp, and affects many systems in the body including the gastrointestinal tract. Schistosomiasis of the appendix is a well-recognized disease and presents as a chronic granulomatous inflammation. This study aims to document the frequency and pattern of distribution of schistosomal appendicitis in our environment.

This is a retrospective histopathological review of schistosomiasis of the appendix in the Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria - Nigeria, between January 1, 1991 to December 31, 2012.

Within the study period, there were 1,464 appendectomy specimens histologically examined in the Pathology Laboratory. Thirty of these, representing 2.1%, were diagnosed as schistosomiasis of the appendix. The male:female ratio was 6.5:1 and peak age incidence was in the 20-29 years age group. Abdominal pains, vomiting and fever were seen in 23 (76.7%) and altered bowel motion in seven (23.3%) patients.

This study showed that schistosomiasis of the appendix is not rare and that its presentation is similar to other forms of appendicitis. There is a need to focus on the prevention of schistosomiasis in order to reduce morbidity among these economically viable age groups.

• Appendicitis
• Nigeria
• schistosomiasis

• Appendectomy
• Appendiceal Neoplasms
• Entamoeba Histolytica
• Enterobius

• Acute appendicitis
• Schistosomiasis

Intestinal schistosomiasis as unusual aetiology for acute appendicitis, nowadays a rising disease in western countries. Recent changes in global migration has led to an immigration growth in our scenario, upsurging people coming from endemic areas of schistosomiasis. Schistosomal appendicitis, seldom reported in developed countries, is now an expected incrising entity in our hospitals during the near future. Due to this circumstances, we believe that schistosomiasis should be consider as a rising source for acute appendicitis in western countries. In order to illustrate this point, we present a case of a 45-years-old black man, from Africa, was admitted via A&E because of acute abdominal pain, located in right lower quadrant. Acute appendicitis was suspected, and he underwent laparotomy and appendectomy. Pathological study by microscope revealed a gangrenous appendix with abscesses and parasitic ova into the submucosal layer of the appendix, suggesting Schistosomiasis.

AIM: To document unusual findings in appendectomy specimens.

METHODS: The clinicopathological data of 5262 patients who underwent appendectomies for presumed acute appendicitis from January 2006 to October 2010 were reviewed retrospectively. Appendectomies performed as incidental procedures during some other operation were excluded. We focused on 54 patients who had unusual findings in their appendectomy specimens. We conducted a literature review via the PubMed and Google Scholar databases of English language studies published between 2000 and 2010 on unusual findings in appendectomy specimens.

RESULTS: Unusual findings were determined in 54 (1%) cases by histopathology. Thirty were male and 24 were female with ages ranging from 15 to 84 years (median, 32.2 ± 15.1 years). Final pathology revealed 37 cases of enterobiasis, five cases of carcinoids, four mucinous cystadenomas, two eosinophilic infiltrations, two mucoceles, two tuberculosis, one goblet-cell carcinoid, and one neurogenic hyperplasia. While 52 patients underwent a standard appendectomy, two patients who were diagnosed with tuberculous appendicitis underwent a right hemicolectomy. All tumors were located at the distal part of the appendix with a mean diameter of 6.8 mm (range, 4-10 mm). All patients with tumors were alive and disease-free during a mean follow-up of 17.8 mo. A review of 1366 cases reported in the English literature is also discussed.

CONCLUSION: Although unusual pathological findings are seldom seen during an appendectomy, all appendectomy specimens should be sent for routine histopathological examination.

• Appendicitis
• Carcinoid
• Unusual findings
• Goblet cell carcinoid
• Enterobius vermicularis
• Mucocele

• Acute Abdomen
• Enterobius vermicularis
• Parasitic Appendicitis
• Taenia